Taylor N A, Liao Z X, Stevens C, Walsh G, Roth J, Putnam J, Fossella F, Allen P, Cox J D, Komaki R
Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
Int J Radiat Oncol Biol Phys. 2003 Jul 1;56(3):616-25. doi: 10.1016/s0360-3016(03)00063-4.
To determine the effectiveness of postoperative radiotherapy (RT) in patients with Stage IIB and Stage IIIA non-small-cell lung cancer (NSCLC) treated with induction chemotherapy followed by surgery.
We retrospectively reviewed the treatment records of 98 patients (58 men and 40 women; median age 61 years, range 31-91) with Stage IIB and Stage IIIA NSCLC who were treated with induction chemotherapy followed by surgery at our institution between January 1990 and December 2000. Patients were grouped by treatment (chemotherapy/surgery alone vs. chemotherapy/surgery/RT), by disease stage and nodal classification. The rates of local control (LC), disease-specific survival, disease-free survival, and overall survival (OS) were calculated using the Kaplan-Meier method.
Of the 98 patients, 40 had Stage IIB and 58 had Stage IIIA. The clinical disease stage and N stage were significantly greater in those patients who underwent RT than in those who did not; however, no statistically significant differences were identified in the additional characteristics between those receiving and not receiving RT within each stage or nodal group. The overall 5-year actuarial LC rate was 81% in the RT group and 54% in the chemotherapy/surgery-alone group (p = 0.07). Postoperative RT significantly improved the 5-year LC rate in patients with Stage IIIA disease (from 35% to 82%, p = 0.01). Postoperative RT did not significantly improve the 5-year OS rate (30% with RT vs. 49% without) for all patients or for patients with Stage IIIA disease. The disease-specific survival and disease-free survival rates did not differ between the treatment groups. Patients who responded to induction chemotherapy had a significantly greater 5-year OS rate (49%) than did those with stable or progressive disease (22%, p = 0.003).
Postoperative RT in patients with Stage IIIA NSCLC treated with induction chemotherapy followed by surgery significantly improved LC without improving OS. Significantly improved survival was observed in all patients who responded to induction chemotherapy compared with those with stable or progressive disease.
确定接受诱导化疗后行手术治疗的IIB期和IIIA期非小细胞肺癌（NSCLC）患者术后放疗（RT）的有效性。
我们回顾性分析了1990年1月至2000年12月期间在本机构接受诱导化疗后行手术治疗的98例IIB期和IIIA期NSCLC患者（58例男性和40例女性；中位年龄61岁，范围31 - 91岁）的治疗记录。患者按治疗方式（单纯化疗/手术与化疗/手术/放疗）、疾病分期和淋巴结分类进行分组。采用Kaplan-Meier方法计算局部控制（LC）率、疾病特异性生存率、无病生存率和总生存率（OS）。
98例患者中，40例为IIB期，58例为IIIA期。接受放疗的患者临床疾病分期和N分期显著高于未接受放疗的患者；然而，在每个分期或淋巴结组内，接受和未接受放疗的患者在其他特征方面未发现统计学显著差异。放疗组的总体5年精算LC率为81%，单纯化疗/手术组为54%（p = 0.07）。术后放疗显著提高了IIIA期疾病患者的5年LC率（从35%提高到82%，p = 0.01）。术后放疗对所有患者或IIIA期疾病患者的5年OS率没有显著改善（放疗组为30%，未放疗组为49%）。治疗组之间的疾病特异性生存率和无病生存率没有差异。对诱导化疗有反应的患者5年OS率（49%）显著高于病情稳定或进展的患者（22%，p = 0.003）。
接受诱导化疗后行手术治疗的IIIA期NSCLC患者术后放疗显著提高了LC，但未改善OS。与病情稳定或进展的患者相比，所有对诱导化疗有反应的患者生存率显著提高。
